Home-based care and standard hospital care for patients with severe mental illness: a randomised controlled trial.

"OBJECTIVE--To compare the efficacy of home based care with standard hospital care in treating serious mental illness. DESIGN--Randomised controlled trial. SETTING--South Southwark, London. PATIENTS--189 patients aged 18-64 living in catchment area. 92 were randomised to home based care (daily living programme) and 97 to standard hospital care. At three months' follow up 68 home care and 60 hospital patients were evaluated. MAIN OUTCOME MEASURES--Use of hospital beds, psychiatric diagnosis, social functioning, patients' and relatives' satisfaction, and activity of daily living programme staff. RESULTS--Home care reduced hospital stay by 80% (median stay 6 days in home care group, 53 days in hospital group) and did not increase the number of admissions compared with hospital care. On clinical and social outcome there was a non-significant trend in favour of home care, but both groups showed big improvements. On the global adjustment scale home care patients improved by 26.8 points and the hospital group by 21.6 points (difference 5.2; 95% confidence interval--1.5 to 12). Other rating scales showed similar trends. Home care patients required a wide range of support in areas such as housing, finance, and work. Only three patients dropped out from the programme. CONCLUSIONS--Home based care may offer some slight advantages over hospital based care for patients with serious mental illness and their relatives. The care is intensive, but the low drop out rate suggests appreciation. Changes to traditional training for mental health workers are required."

Influence of experience and nationality on assessment and outcome of parasuicide.

In Sheffield 544 consecutive cases of attempted suicide (parasuicide) were seen at 2 large hospitals over a 12-month period, and allocated in sequence to the junior and senior psychiatric staff, of British and foreign origin. During the follow-up period of 12 months, 31 patients had a further episode of parasuicide and 5 patients committed suicide. The outcome (as measured by repeat parasuicide or suicide) was not significantly affected by the country of origin of the psychiatrist, nor his length of training in psychiatry.

Incidence of depressive symptoms in users of the oral contraceptive.

Evidence is presented that the incidence of depression among users of oral contraceptives is no higher than that among matched controls not taking such medication. There is an association between high depression scores and high neuroticism scores, more marked in controls than takers. Intensity of depression is related more to age, personality and occupation than to the use of oral contraceptives. A higher proportion of users than of controls experience sexual satisfaction. Past takers include a large number of individuals with a high neuroticism score. The incidence of depression symptoms in women increases with age. A higher proportion of housewives than of women going out to full-time work show depressive symptoms.

PIP: The incidence of depression was found to be unrelated to the use of oral contraceptives in this study, which used controlled samples and defined criteria for measuring depression. The survey, conducted in the general practice of one of the authors, was based on the population of a predominantly working class area and used the technique of the Royal College of General Practitioners Oral Contraceptives Study. 335 women currently taking oral contraceptives, mostly combined pills, were matched for age with 2 groups of controls: 172 past takers and 179 non-takers. 3 questionnaires were used: 1) information about the patient's current menstrual history, medical and psychiatric state, 2) a depression rating scale with scores 0-6 indicating virtual absence of depression, 7-12 mild depressive symptoms, and 13+ depressive illness, and 3) The Eysenck Personality Inventory, used to gauge levels of neuroticism. The following results were obtained. 1) the depression scores of non-takers and takers were similar, those of past takers higher; 2) takers and non-takers displayed similar neuroticism scores, while past takers had a smaller percentage of low-neuroticism scores, but higher percentages of scores above 11; and 3) 20% of takers, 22% of non-takers, and 29% of past takers reported diminished libido. An examination of depressive symptoms and certain social and personal factors revealed a positive relationship, which was unaffected by the use of oral contraceptives. Depressive symptoms increased with age in all groups, but particularly in the controls; depression scores in all groups remained unchanged during the premenstrual stage; and depression was more pronounced the higher the number of children and less pronounced in women going out to work. A comparison of neuroticism and depression scores showed a disproportion in controls with high depression and neuroticism scores; neurotic women produce more depressive symptoms and presumably blame them on the pill. 6 tables, 3 figures, and 2 appendices accompany this article.

Requests for termination of pregnancy in the East Midland area--Sheffield region.

A study was carried out of patients seeking termination of pregnancy through their general practitioners. Three quarters of these patients were recommended for termination. Of these 80 per cent did, ultimately, have the pregnancy aborted. A number of patients showed guilt feelings but anything approaching mental illness occurred in only two patients.